A comparison of two concentrations of bupivacaine and adrenaline with and without fentanyl in paediatric inguinal herniorrhaphy

Abstract

This study was designed to determine whether administration of caudal bupivacaine with fentanyl would have any effect on analgesia in paediatric patients undergoing inguinal herniorrhaphy repair. Fifty-six outpatient paediatric patients undergoing inguinal hernia repair were evaluated. Patients received, in a randomized manner, 1 ml.kg-1 of either bupivacaine 0.25% or 0.125% with or without fentanyl 1 microg.kg-1. There was no difference in pain scores in the hospital, the night of surgery, or 24 h postoperatively nor was there a difference in the oral analgesics administered between any of the groups. There was a higher incidence of vomiting at home in both 0.25% bupivacaine groups irrespective of the use of fentanyl. The 0.125% bupivacaine group had significantly more patients who received intravenous fentanyl in the PACU than did the other three groups (P<0.001). Increasing the concentration of bupivacaine from 0. 125% to 0.25% increased the incidence of postoperative vomiting. We recommend that clinicians utilize bupivacaine 0.125% with 1 microg. kg-1 fentanyl as the caudal injectate in paediatric patients undergoing inguinal hernia repair.

Comparison of fentanyl–bupivacaine or midazolam–bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children

“…Joshi et al . (10) found that there were no differences between caudal 1 ml·kg −1 bupivacaine 0.25% and 0.125% with or without fentanyl 1 µg·kg −1 in pain scores or analgesic requirement in patients who underwent inguinal hernia repair. Campbell et al .…”

The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia

“…Ropivacaine has become the agent of choice in paediatric epidural analgesia due to the lower incidence of cardiotoxicity and central nervous system toxicity 2 . Adjuvant opioids to local anaesthetics have been studied to allow better analgesia without increasing the incidence of adverse effects with varying results 1–3,7,8 . The effective concentration of ropivacaine for caudal analgesia ranges from 1.3 to 2.0 mg/ml when ropivacaine was used alone 9–12 .…”

Prevention of post‐operative nausea and vomiting in children – a prospective randomized double‐blind study

“…The dose of bupivacaine in our study was 0.25% (1mL/kg) regarding the caudal blocks. A comparison between the 0.25% and 0.125% caudal bupivacaine on 56 outpatient paediatric patients undergoing inguinal hernia repair, showed that the 0.25% bupivacaine was related with a higher incidence of vomiting at home, irrespective of the use of fentanyl (19).…”